What's All This Commotion with Congress and Healthcare?

Last week, by a narrow 2-vote margin, Congress passed proposed changes in rules for health insurance in the US, called the American Health Care Act (AHCA). The bill now goes on to the Senate. But what's in AHCA? What does it fundamentally change about health insurance? The answer is almost everything. If this becomes law, AHCA will repeal most provisions of the Affordable Care Act (known as ACA or Obamacare). There's not much of a replacement, though. AHCA brings us back to the pre-ACA rules for health insurance, rather than setting up new governing laws. 

 What will happen if this becomes law? Here's a starting list of what I felt were some of the most important things to know. 

•States can decide if they will allow pre-ACA rules for pre-existing conditions
Currently under the Affordable Care Act, health insurance companies can't deny you or charge you more for pre-existing conditions. 

•Legal surcharges for age (up to 5x)
Under the current ACA rules, the surcharges are capped at 3 times a younger person. AHCA would allow up to 5 times. 

•Dismantling of the Marketplace?
The AHCA bill doesn't give us a clear answer. The Marketplace is great because you can compare plans side by side, by zipcode.  Will consumers be able to see prices and compare plans side by side? We don't know. 

•Stripping of essential health benefits
Under the current Affordable Care Act there are 10 essential health benefits like doctor's visits, surgery, prescription drug coverage, mental healthcare, and maternity care. Before ACA, most individual insurance companies outright refused to cover any mental health, maternity care, or prescription drugs. We could be looking at a return to the days when insurance companies get to decide what they cover and what they do not. 

•Subsidies for premiums based solely on age AND No subsidies for cost sharing reductions
Proposed subsidies range from $2,000 to $4,000 per year. For everyone below 400% of the Federal Poverty Level (yearly income of $48,240 for an individual,  $98,400 for a family of 4) that would mean a sharp increase in premiums. I personally would pay approximately $1,480 in yearly premiums for my current plan. 
AHCA also takes away cost sharing reductions, which help reduce out of pocket costs (deductibles, out of pocket maximums, copays) for lower income people. The new rule would make it so a millionaire and a person on Social Security disability pay the same premiums, deductibles, and out of pocket maximums. 

•No regulations for out of pocket maximums or deductibles
The current Affordable Care Act mandates that insurance companies have a maximum out of pocket every year for each person. The number in 2017 is $7,150 for an out of pocket maximum and $6,550 for a deductible. Under AHCA, there would be no mandated limit, and insurance companies could simply choose how much you have to spend before they cover you. 

•Bringing back lifetime limits for employer-based plans
Before the current Affordable Care Act, insurance companies could choose an amount that they would pay up to, then you would have no coverage. Most were around $500,000 to $1million per lifetime. Anyone who has had a serious condition like cancer knows that a single year can cost around these limits. The Affordable Care Act turned this practice on its head--ACA mandates that plans cannot set any lifetime limits and must cover you when you get sick! These rules will be repealed under AHCA. 

•Bringing back high risk pools
Before the Affordable Care Act, when companies could deny people based on their health, we had high risk pools. In Wisconsin, it was called HIRSP. Risk pools are expensive insurance options run by the state and funded by premiums of members. HIRSP was extremely expensive (often half or more of a person's monthly income) and had a 6 month wait period during which a person had to pay premiums but couldn't get any healthcare. AHCA proposes going back to this model. 

•Block granting Medicaid, and ending expansion
Currently in Wisconsin, BadgerCare Plus covers almost everyone without access to other insurance who are under 100% of the Federal Poverty Level.  Keep in mind that the governor is currently in the process of trying to change this so that a person can only be on BadgerCare for 4 years of their lifetime. But even further,  under AHCA, Wisconsin would be able to cap enrollments so no one new can get into the program (and there is no doubt that the current governor would do so). That means if you lose your job and don't have income, you won't have any access to insurance unless you buy it at full price. 

The Affordable Care Act can be pricey, and it isn't perfect. But it's much better than AHCA. The current administration and leaders in Congress have made no promises that AHCA will be more affordable. We need to do much better than simply repealing the Affordable Care Act and replacing it with air.  Whatever your side on this issue,  I encourage you to call your Senator to voice your opinion.